Pelvic Radiographs

Some authors argue that if a child is to undergo an abdominal or pelvic CT for trauma evaluation then the AP radiograph is superfluous (Ersoy et al. 1995) and the screening pelvic radiograph should be reserved for patients in whom abdominal CT is not indicated. 

Injury to the metallic core of malleable prosthe-ses can be detected on pelvic radiographs (Cohan et al. 1989 Hovsepian and Amis 1989 Chiou et al. 1999). Despite the excellent radiopacity of the silver core, however, diagnosis is often difficult, and many fractures have been missed or their severity underestimated using standard radiographic technique. Modern inflatable penile prostheses usually contain saline, which cannot be seen radiographically. 

Kane s classification of pelvic radiograph s helps to convey the gravity of the bony injury (See Table 5.1). 

Radiographic imaging studies evaluate the extent of disease involvement. A chest x-ray should be performed to rule out the presence of metastatic spread to the lungs. A CT scan of the abdomen and pelvis is often performed to evaluate hepatic and retroperitoneal involvement and occult abdominal and pelvic disease, and to determine the depth of tumor penetration into the bowel wall and/or invasion to adjacent organs. Detection of lymph node involvement with either smdy is limited by the difficulty of distinguishing inflammatory or reactive lymph nodes from those infiltrated with tumor. Because CT scans may not adequately detect peritoneal seeding, small distant lymph node metastasis, or liver metastasis in colon cancer, an occasional patient may... 

Kuligowska E, Deeds L et al. (2005) Pelvic pain overlooked and underdiagnosed gynecologic conditions. Radiographics 25 3-20... 

Saksouk FA, Johnson SC (2004) Recognition of the ovaries and ovarian origin of pelvic masses with CT. Radiographics 24 133-146... 

Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. Radiographics 22 295-304... 

Pannu HK, Kaufman HS, Cundiff GW, et al. (2000) Dynamic MR imaging of pelvic organ prolapse spectrum of abnormalities. Radiographics 20 1567-1582... 

Sam JW, Jacobs JE, Birnbaum BA (2002) Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics 22 1327-1334... 

Bennett GL, Slywotzky CM, Giovanniello G et al (2002) Gynecologic causes of acute pelvic pain spectrum of CT findings. Radiographics 22 785-801... 

The AP radiograph is useful in demonstrating pelvic fractures, but it may miss some injuries (Berg et al. 1996). While additional views such as the inlet and outlet, may detect further fractures, their use is no longer indicated if there is reasonable access to CT imaging. 

The AP radiograph should be closely reviewed for signs of pelvic ring discontinuity by identifying various anatomical lines, the absence of which implies ring disruption or a fracture. These lines are the ischio-ilial line, ilio-pectineal line, and the anterior and posterior acetabular walls. The ilio-ischial line is formed by the posterior structures of the pelvis and the ilio-pectineal by the anterior acetabular structures (Ersoy et al. 1995) (Fig. 12.3). 

Approximately 30% of pelvic fractures seen on CT can be missed on plain films (Resnik et al. 1992 Berg et al. 1996). In particular, AP radiographs may miss sacroiliac diastasis, acetabular, intra-articular and vertical shear fractures (Montana et al. 1986 ... 

This is usually the result of forces transmitted through the axial skeleton from an impact into the head and shoulders through to the lower limbs. There may be symphyseal diastasis, anterior arch fractures or posterior disruption of the sacroiliac joints with cephalic displacement. Vertical injuries are often severe with disruption of all the ligaments plus associated pelvic instability. Radiographs demonstrate ipsilateral or contralateral pubic rami fractures, with disruption of the sacroiliac joint. The major differentiating feature from compression injuries is the cephalic displacement of the pelvis on the side of the impact (Fig. 12.14). 

Keshishyan, RA, Rozinov VM, et al. (1995) Pelvic polyfractures in children. Radiographic diagnosis and treatment. Clin Orthop Relat Res (320) 28-33 Langenskiold A (1993) Partial closure of the epiphyseal plate. Principles of treatment. 1978. Clin Orthop Relat Res (297) 4-6... 

Ptak T, Rhea JT, Novelline RA (2003) Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method initial experience. Radiology 229 902-905 Resnik CS, Stackhouse DJ, Shanmuganathan K etal. (1992) Diagnosis of pelvic fractures in patients with acute pelvic trauma efficacy of plain radiographs. AJR Am J Roentgenol 158 109-112... 

Niwa T,Takebayashi S et al. (2000) The value of plain radiographs in the prediction of outcome in pelvic fractures treated with embolisation therapy. Br J Radiol 73(873) 945-... 

Daneman A, Alton DJ (1991) Radiographic manifestations of renal anomalies. Radiol Clin North Am 29 351-363 Downs RA, Lane JW, Burns E (1973) Solitary pelvic kidney its clinical implications. Urology 1 51-56 Evans WP, Resnick MI (1981) Horseshoe kidney and urolithiasis. J Urol 125 620-621... 

Fig. 6.1. AP radiograph of the pelvic cavity showing widening of the pubic symphysis in a girl with vesical exstrophy...

Radiographically uninhibited detrusor contractions are manifested by a small or moderate amount of contrast agent flowing into the posterior urethra, where it is stopped above the pelvic floor by either a reflexive contraction of the external sphincter or a static distal sphincter obstruction (Mundy et al. 1985) (Fig. 16.6). 

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